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ORIGINAL ARTICLE
Year : 2012  |  Volume : 49  |  Issue : 3  |  Page : 283-286
 

Accuracy of imaging-guided biopsy in diagnosis of malignancy versus infection


1 Department of Pediatrics,Division of Pediatric Hematology-Oncology,Bezmialem Vakif University School of Medicine, Istanbul, Turkey
2 Anadolu Medical Center, Pediatric Hematology-Oncology, Istanbul, Turkey
3 Acibadem University School of Medicine, Pediatric Hematology-Oncology, Istanbul, Turkey
4 Marmara University School of Medicine, Interventional Radiology, Istanbul, Turkey
5 The Children's Hospital at Monmouth Medical Center, Department of Pediatrics, Long Branch, NJ 07740, USA

Date of Web Publication12-Dec-2012

Correspondence Address:
S G Berrak
The Children's Hospital at Monmouth Medical Center, Department of Pediatrics, Long Branch, NJ 07740
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.104488

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 » Abstract 

Aims: Imaging-guided biopsies obtain samples for pathologic testing in addition to therapeutic interventions in patients with cancer. Our aim was to determine the diagnostic accuracy of percutaneous biopsies of pediatric solid tumors and infectious complications of cancer treatment. Materials and Methods: This study was performed by gathering pediatric oncology patients between 1998 and 2008. A total of 41 percutaneous biopsies were performed in order to establish a diagnosis for a suspected malignancy or an infectious complication of cancer treatment. Results and Conclusions: An accurate diagnosis was achieved in 21 of 26 (87.6%) percutaneous biopsies for suspected malignancy cases or recurrence. The remaining 15 percutaneous biopsies were done for the diagnosis of infectious complications of cancer treatment with an accurate diagnosis of 60%. Imaging-guided percutaneous biopsy technique is highly accurate and safe, particularly in diagnosis of a suspected tumor.


Keywords: Imaging-guided biopsy, pediatrics, malignancy


How to cite this article:
Cakir F B, Genc D B, Canpolat C, Aribal E, Berrak S G. Accuracy of imaging-guided biopsy in diagnosis of malignancy versus infection. Indian J Cancer 2012;49:283-6

How to cite this URL:
Cakir F B, Genc D B, Canpolat C, Aribal E, Berrak S G. Accuracy of imaging-guided biopsy in diagnosis of malignancy versus infection. Indian J Cancer [serial online] 2012 [cited 2019 Dec 14];49:283-6. Available from: http://www.indianjcancer.com/text.asp?2012/49/3/283/104488



 » Introduction Top


Solid tumors in childhood often present a diagnostic problem. Computerized tomography (CT), ultrasonography (US) or magnetic resonance imaging (MRI) scans may be typical but only suggestive. Since patients with malignant tumors are treated with tumor-specific chemotherapy regimens, diagnosis is mandatory. Although fine-needle aspiration cytology is suggested to be an alternative method to invasive surgical biopsy, cytology alone may not be capable of distinguishing between several types of small blue round tumors encountered in childhood. Imaging-guided percutaneous core needle biopsy (PCNB) has become an accepted diagnostic procedure for a variety of lesions including infectious complications of cancer treatment due to its relative ease, safety, and cost-effectiveness. [1],[2]

We conducted the current study to determine the accuracy of diagnoses made using PCNB of suspected malignancies and infectious complications of cancer treatment in our center.


 » Materials and Methods Top


We retrospectively gathered data between 1998 and 2008 on a total of 41 imaging-guided PCNB performed in 33 patients either for pretreatment diagnosis of a suspected malignancy, for confirming recurrence of a known malignancy, or an infectious complication of cancer treatment. PCNB procedures were performed by experienced radiologists with general anaesthesia or under sedation and with local anaesthesia under the guidance of either CT or US depending on the preference of the radiologist. The needle used most often was a 16-gauge tru-cut, core biopsy needle. All children stayed in bed for 24 h after the biopsy and vital signs were monitored until the children were fully alert. Verification of the biopsy results was made with subsequent surgical pathology findings, the patient's response to treatment and clinical follow-up for at least one year.


 » Results Top


There were 19girls and 14 boys with a median age 96 months (range 5 months to 16 years). PCNB procedures were performed on 41 occasions in 33 patients. An acute myeloid leukemia patient required three US-guided stent placement procedures performed on three different occasions for both diagnosis and treatment of abdominopelvic infection. Five children undervent two PCNBs of the same lesion on two different occasions due to failure of the first intervention to yield diagnostic material. The patient, who was diagnosed as pancreatoblastoma via abdominal PCNB at initial presentation, was subsequently treated with US-guided stent placement through biliary system in order to relieve obstructive jaundice. The remaining 26 patients had a single intervention [Table 1],[Table 2].
Table 1: Summary of the percutaneous core needle biopsies in patients with suspected malignancy

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Table 2: Summary of the percutaneous core needle biopsies in patients with infectious complications of cancer treatment

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Accurate diagnosis was established in 21 of 26 (87.6%) PCNBs in 22 patients for suspected malignancy or recurrence; hence five PCNBs were not diagnostic. Four patients in this group obtained diagnosis through the second PCNB. Open biopsy was needed in one patient for the accurate diagnosis of nasopharyngeal carcinoma. Excluding this patient undergoing open surgery, of the 21 patients who obtained diagnosis through PCNBs, in 11 patients the diagnosis was confirmed later by surgery; in 10 patients it was verified by clinical follow-up [Table 1].

The remaining 15 PCNBs [stent placement (n=4)] were done in 12 patients for the diagnosis of infectious complications of cancer treatment. An accurate diagnosis was achieved in 9 of 15 (60%) PCNBs in this group. Six thoracic PCNBs were inconclusive [Table 2]. Thoracic approach was repeated in one patient and resulted in a diagnosis of a fungal infection. We were not able to obtain a second PCBN in the remaining five patients due to their unstable respiratory signs. Four patients with a clinical suspicion of fungal infection were treated succesfully with appropriate antifungal antibiotics with regression of their lung nodules. Parenchymal nodule of another patient with Hodgkin's disease having suspicion of tuberculosis infection disappeared with prophylactic antituberculous treatment concurrent with chemotherapy. Therefore we could not decide whether this nodule was a malignant or an infectious one. This patient is in remission with both clinical and radiological follow-up for four years. In this group, four US-guided stent replacements for both diagnosis and treatment of infections were succesfully performed without complication [Table 2].

A single complication was bleeding from the biopsy site through a thoracic intervention. The patient required transfusion and remained hospitalized until recovery without subsequent treatment.


 » Discussion Top


Our results have shown percutaneous imaging-guided biopsy to be an accurate and a reliable method of making particularly correct diagnosis of cancer in children. The technique was accurate in 21 of 26 (87.6%) malignant biopsies of which 11 were confirmed by surgical pathology and 10 by clinical follow-up for at least one year. This is in concordance with several other series that have dealt with malignant tumors in children. [2],[3],[4],[5],[6] One of the largest series, specifically performed in pediatric solid tumor patients, reported 93% diagnostic accuracy confirmed by subsequent surgery or by outcome. [2] Hussein et al., established accurate diagnosis in 28 of 34 (88%) percutaneous biopsies with surgical verification in 22 and with clinical and radiological features of the tumor in six. [3] Similar to our study, several studies reported both malignant and benign PCBNs including accuracy rates. [4],[5],[6] Skoldenberg et al., identified a diagnostic accuracy of 89% in 131 of 147 cutting biopsies obtained from both malignant and benign lesions. [4] Hugosson et al., reported diagnostic accuracy in 35 of 37 (95%) needle core biopsies consisting of 27 malignant and 10 benign pathologies with confirmation of diagnosis mostly by clinical assessment. [5] Willman revealed seven subsequently regressed inflammatory needle core biopsies. [6] Nine infectious PCNBs in our study were verified by subsequent disappearance of the lesions with appropriate antibiotic treatment. Diagnostic accuracy is lower (60%) in infectious PCNBs, particularly from thoracic intervention in our series. Some of the previous studies demonstrated lower diagnostic accuracy of percutaneous lung biopsies for benign disease than those for malignant disease. [7],[8] Mitruka et al., in 312 CT-guided lung biopsies, reported lower (71%) diagnostic accuracy in benign lesions than malignant ones (86%). [7] Kothary et al., had a diagnostic accuracy of 45.9% in 17 of 37 needle biopsies of benign lung nodules and they suggested that small nodules might represent a benign entity. [8] Inconclusive benign infectious nodules (n=5) in our study were small lesions (≤2 cm) probably due to the state of immunosuppression of the patients. Kothary demonstrated a diagnostic accuracy of 51.4% in nodules measuring ≤1.5 cm compared with 73.5% in nodules >1.5 cm. [8] Ohno et al., established a significantly low diagnostic accuracy of CT-guided biopsies in nodules measuring <2 cm. [9] Positional changes of lung nodules because of respiratory motion can also be technically more challenging than in other biopsy locations. [10] The findings from these studies have demonstrated that tissue adequate for diagnosis is obtained in almost 95% of cases. Furthermore, in the studies that provided such information, almost all cases in which the initial biopsy was deemed inadequate yielded adequate samples on repeat biopsies. Additionally, PCNB of musculoskeletal lesions in children have been performed satisfactorily which show accuracy rates ranging from 74-96%. [11],[12] In these circumstances either the bone or soft tissue component has been subjected to biopsy and evaluation.

Bleeding is a well-known complication in PCNB and probably is related to the small lesion size, long distance to the lesion and to the diameter of the needle. [13] We experienced a single bleeding complication through thoracal intervention that subsided with supportive measures.

PCNB is a safe and accurate technique, particularly for diagnosis and also for the treatment in pediatric oncology and helping to avoid surgery in most of the cases which might cause a delay in initiating treatment. Accuracy is higher for malignant lesions versus benign lesions and larger versus smaller ones. PCNB should be considered the method of choice in children that obviates more invasive interventions in most patients.

 
 » References Top

1.Hoffer FA. Interventional radiology in pediatric oncology. Eur J Radiol 2005;53:3-13.  Back to cited text no. 1
[PUBMED]    
2.Garrett KM, Fuller CE, Santana VM, Shochat SJ, Hoffer FA. Percutaneous Biopsy of Pediatric Solid Tumors. Cancer 2005;104:644-52.  Back to cited text no. 2
[PUBMED]    
3.Hussain HK, Kingston JE, Domizio P, Norton AJ, Reznek RH. Imaging-Guided Core Biopsy for the Diagnosis of Malignant Tumors in Pediatric Patients. AJR Am J Roentgenol 2001;176:43-7.  Back to cited text no. 3
[PUBMED]    
4.Skoldenberg EG, Jakobson A, Elvin A, Sandstedt B, Olsen L, Christofferson RH. Diagnosing childhood tumors: a review of 147 cutting needle biopsies in 110 children. J Pediatr Surg 2002;37:50-6.  Back to cited text no. 4
    
5.Hugosson CO, Nyman RS, Cappelen-Smith JM, Akhtar M. Ultrasound-guided biopsy of abdominal and pelvic lesions in children: a comparison between fine-needle aspiration and 1.2-mm needle core biopsy. Pediatr Radiol 1999;29:31-6.  Back to cited text no. 5
    
6.Willman JH, White K, Coffin CM. Pediatric core needle biopsy: strengths and limitations in evaluation of masses. Pediatr Dev Pathol 2001;4:46-52.  Back to cited text no. 6
[PUBMED]    
7.Mitruka S, Landreneau RJ, Mack MJ, Fetterman LS, Gammie J, Bartley S, et al. Diagnosing the indeterminate pulmonary nodule: percutaneous biopsy versus thoracoscopy. Surgery 1995;118:676-84.  Back to cited text no. 7
    
8.Kothary N, Lock L, Sze DY, Hofmann LV. Computed Tomography-Guided PercutaneousNeedle Biopsy of Pulmonary Nodules: Impact of Nodule Size on Diagnostic Accuracy. Clin Lung Cancer 2009;10:360-3.  Back to cited text no. 8
[PUBMED]    
9.Ohno Y, Hatabu H, Takenaka D, Higashino T, Watanabe H, Ohbayashi C, et al. CT-guided transthoracic needle aspiration biopsy of small (< or = 20mm) solitary pulmonary nodules. Am J Roentgenol 2003;180:1665-9.  Back to cited text no. 9
    
10.Hoffer FA, Kozakewich H, Shamberger RC. Percutaneous biopsy of thoracic lesions in children. Cardiovasc Intervent Radiol 1990;13:32-5.  Back to cited text no. 10
    
11.Hau A, Kim I, Kattapuram S, Hornicek FJ, Rosenberg AE, Gebhardt MC, et al. Accuracy of CT-guided biopsies in 359 patients with musculoskeletal lesions. Skeletal Radiol 2002;31:349-53.  Back to cited text no. 11
    
12.Logan PM, Connell DG, O'Connell JX, Munk PL, Janzen DL. Image-guided Percutaneous biopsy of musculoskeletal tumors: an algorithm for selection of specific biopsy techniques. AJR Am J Roentgenol 1996;166:137-41.  Back to cited text no. 12
    
13.Yeow KM, See LC, Lui KW, Lin MC, Tsao TC, Ng KF, et al. Risk factors for pneumothorax and bleeding after CT-guided percutaneous coaxial cutting needle biopsy of lung lesions. J Vasc Interv Radiol 2001;12:1305-12.  Back to cited text no. 13
    



 
 
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